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A subtle governance: ‘soft’ medical leadership in English primary care
Author(s) -
Sheaff R.,
Rogers A.,
Pickard S.,
Marshall M.,
Campbell S.,
Sibbald B.,
Halliwell S.,
Roland M.
Publication year - 2003
Publication title -
sociology of health and illness
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.146
H-Index - 97
eISSN - 1467-9566
pISSN - 0141-9889
DOI - 10.1111/1467-9566.00352
Subject(s) - bureaucracy , parallels , corporate governance , autonomy , clinical governance , public relations , primary care , health care , political science , public administration , medicine , management , politics , economics , law , family medicine , operations management
In many countries governments are recruiting the medical profession into a more active, transparent regulation of clinical practice. Consequently the medical profession adapts the ways it regulates itself and its relationship to health system managers changes. This paper uses empirical research in English Primary Care Groups (PCGs) and Primary Care Trusts (PCTs) to assess the value of Courpasson's concept of soft bureaucracy as a conceptualisation of these changes. Clinical governance in PCGs and PCTs displays important parallels with governance in soft bureaucracies, but the concept of soft bureaucracy requires modification to make it more applicable to general practice. In English primary care, governance over rank‐and‐file doctors is exercised by local professional leaders rather than general managers, harnessing their colleagues’ perception of threats to professional autonomy and self‐regulation rather than fears of competition as the means of ‘soft coercion’.